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. 2018 Nov 16;4(2):e000752.
doi: 10.1136/rmdopen-2018-000752. eCollection 2018.

Comparing the disease course of patients with seronegative and seropositive rheumatoid arthritis fulfilling the 2010 ACR/EULAR classification criteria in a treat-to-target setting: 2-year data from the ARCTIC trial

Lena Bugge Nordberg  1   2 , Siri Lillegraven  1 , Anna-Birgitte Aga  1 , Joseph Sexton  1 , Inge Christoffer Olsen  1   3 , Elisabeth Lie  1 , Hilde Berner Hammer  1 , Till Uhlig  1 , Desirée van der Heijde  1   4 , Tore K Kvien  1 , Espen A Haavardsholm  1   2
Affiliations

Comparing the disease course of patients with seronegative and seropositive rheumatoid arthritis fulfilling the 2010 ACR/EULAR classification criteria in a treat-to-target setting: 2-year data from the ARCTIC trial

Lena Bugge Nordberg et al. RMD Open. .

Abstract

Objectives: Recent studies suggest that implementation of the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for rheumatoid arthritis (RA) leads to higher inflammatory activity in seronegative compared with seropositive patients at time of diagnosis. Our aim was to compare the disease course in seronegative and seropositive patients classified according to the 2010 criteria.

Methods: DMARD-naïve patients with RA fulfilling the 2010 criteria were included in the treat-to-target ARCTIC trial and followed for 24 months. We stratified patients as seropositive (rheumatoid factor (RF)+, anticitrullinated protein antibodies (ACPA)+ or both) or seronegative (RF- and ACPA-) and compared disease activity, radiographic progression, treatment response and remission rates across groups.

Results: 230 patients were included with mean (SD) age 51.4 (13.7) years, and 61% were female. 34 patients (15%) were seronegative. At 24 months, disease activity measures, radiographic progression and remission rates were similar between groups, despite more inflammatory activity in seronegative patients at baseline. Treatment response was slower in seronegative compared with seropositive patients. The groups received similar treatment.

Conclusion: Our findings suggest that among patients with RA classified according to the 2010 ACR/EULAR criteria, seronegative patients respond well to modern treatment strategies. However, treatment response was somewhat slower in seronegative patients and radiographic progression was similar in seronegative and seropositive patients. Our results indicate that seronegative RA is not a mild form of the disease and requires intensive treat-to-target therapy similar to treatment of seropositive RA.

Keywords: anti-CCP; early rheumatoid arthritis; epidemiology; rheumatoid arthritis; rheumatoid factor.

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Conflict of interest statement

Competing interests: EAH has received research funding from Pfizer, UCB, Roche, MSD and AbbVie for the submitted work, honorariums as a speaker from Pfizer, UCB, Roche and AbbVie and honorariums for development of educational material from Pfizer and Eli Lilly and has sat on advisory boards for Pfizer, Eli Lilly, Celgene and Janssen-Cilag. A-BA has sat on advisory boards for UCB, AbbVie and Pfizer and received honorariums for development of educational material for UCB. HBH has received honorariums as a speaker from AbbVie, Bristol-Myers Squibb, Roche, UCB Pharma, Novartis and Pfizer. DvdH has received consultancy honorariums from AbbVie, Amgen, Astellas, AstraZeneca, Bristol-Myers Squibb, Celgene, Daiichi, Eli Lilly, Galapagos, Merck, Novartis, Pfizer, Roche, Sanofi Aventis, Janssen and UCB and is owner of Imaging Rheumatology. TKK has received consultancy honorariums from AbbVie, Bristol-Myers Squibb, Celltrion, Epirus, Hospira, Merck-Serono, MSD, Orion Pharma, Pfizer, Roche and UCB. TU has received honorariums as a speaker from AbbVie, Bristol-Myers Squibb, Lilly, Roche, Novartis, UCB Pharma and Pfizer. ICO has received consultancy honorarium from Pfizer.

Figures

Figure 1
Figure 1
(A–F) Disease activity measures and radiographic progression 0–24 months in seronegative and seropositive patients. (A–E) Margins plot over 24 months of DAS, SJC44, ultrasound power Doppler score, ultrasound grey scale Score and radiographic progression. Bars represent 95% CIs. (F) Cumulative probability plot of change between baseline and 24 months in Van der Heijde modified sharp score. DAS, Disease Activity Score; SJC, swollen joint count.
See this image and copyright information in PMC

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